Job Title

Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.

The Program Director is a key Quality Improvement (QI) leader within the organization, empowered to advise senior management and other departments on Quality strategies and initiatives. This is an individual contributor role that leads programs/projects in one or more of the following critical QI functional areas: HEDIS Performance Measurement, which conducts data collection, reporting and monitoring for key performance measurement activities; Quality Reporting, which develops reports to meet QI requirements and oversees the use of automated software tools and processes; Clinical Quality Interventions, which develops, implements and monitors the success of QI activities; and QI Compliance, which provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities.

Serves as a QI subject matter expert and leads programs to meet critical Quality needs.

Manages QI programs with oversight from the Director, AVP and VP as needed.

Collaborates and facilitates activities with other units at Corporate and within Molina State Plans.

Provides direction for QI program activities with department leadership including leading Corporate quality initiatives that require timely follow-up, tracking and communication on an on-going basis.

Communicates with and escalates gaps and barriers in implementation and compliance to department leadership, including proposed resolution.

Monitors and tracks key quality indicators, programs, and initiatives to reflect the value and effectiveness of the quality program.

Develops and ensures that automated reporting and interventions tools are implemented effectively (through development, training and roll out).

Collaborates with Molina State Plans to identify areas and strategies for improved reporting and use of reporting tools.

Leads key Clinical Intervention activities including implementation of national and state-based Quality interventions, meeting state and federal intervention rules and aligned with best practices identified in literature and within Molina plans.

Works with Molina Plans and QI leadership to ensure that interventions are communicated, monitored, and reported on a timely basis to demonstrate program effectiveness.

Facilitates and builds high quality clinical care/services through relationships with key departments within Molina and at Molina plans.

Leads HEDIS Performance Measurement programs using knowledge, skills and technical expertise in performance measurement, data collection and reporting.

Maintains confidentiality and complies with the Health Insurance Portability and Accountability Act (HIPAA).

Required Education: Bachelor's Degree or equivalent combination of education and work experience.

Required Experience:

Minimum of 7+ years relevant experience, including at least 5 years in health plan quality improvement.

Demonstrated knowledge of and experience with HEDIS programs.

2 years Medicaid experience

2 years Medicare experience

3 years management experience

Operational knowledge and experience with Excel and Visio (flow chart equivalent).

Proficiency with data manipulation and interpretation.

NCQA Accreditation experience.

Preferred Education: Master's Degree or higher in a clinical field, IT, Public Health or Healthcare Administration.

Preferred Experience:

HEDIS reporting or collection experience

CAHPS improvement experience

State QI experience

3 years' experience in Reporting & Analytics

3 years' experience in Health Care Industry

Quality program leadership and direction

Preferred License, Certification, Association:

Certified Professional in Health Quality (CPHQ)

Nursing License (RN may be preferred for specific roles)

Certified HEDIS Compliance Auditor (CHCA)

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.